Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 91753 | TN |
NPI | 1003880634 |
---|---|
Provider Name | Neil W. Worf |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-2607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 23/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3348915 | (05) | TN |
P89524 | (02) |